04030087 CITY OF CUPERTINO '^^�^
BUILDING DIVISIONPERMIT ' ,�Q�1TI2AGTC)R'IN�'„-0;R11'xA'TXQN
BUIEDlNr ADDRUS: CENTEX HOMES PERMIT ND04030087
jr, RATihipnw DR T,r)T
OWNER'S NAME: PERMIT ISSUE DATE
CENTEX
SANITARY NO. CONTROL NO.
(925) 415-1600
ARCHITE
25 415-
ARCHITEC(ENGINEER: BURDINO PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
SecJobDescription
16 1 hereby cairn dtabi am licensed under provisions of Chapter 9(commencing
with tion 7")ol'DivWon 3 of Me Business Professions Code,said my license is
I.fall to=
andercea.
514 LeeM.nse Cla IJc. SFDWL-3 STORY (PLAN 2)
N
z Dam Contrecmr LIVING ac@-W /GARAGE SQ FT
0 ARCHITECTS DECLARATION
'ySII1 undenund my plans shell W used u public records
3 Licensed Professional
OWNER-BUILDER DECLARATION
+� 1 hereby affirm that 1 am exempt from Me Convenor's Lkense Law for the
`o o following mann.(Schon 7031.5,Business and Professions Code:Any City Or County
$ which acquires a permit m conamct&Iter,improve,demaliJt or repair any snucture
Fzie Prior m its issuance,also requires dicepplicant forsuch PCnnit m file a signed stsement
a nal he is licensed pursuant in de prov161eN or de ComKlaes IJRMC Law(Chapter 9 Sq.Ft. Floor Area Va!PA09'700
,SCS (commencing with Secdon 7000)of Division 3 ofthe Busimsand Pmrmions Cock)or
a that he is attempt tMmfram and the Wig far Be Alleged e¢mptmn.Any violation of
Secdon 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of NNumber Occupancy Type
as mere Nut Into hundred deal($50t. FIN 1 0 0 v,
❑I,ss owner of Ne property,m my employm with wages u dick sale compenudon,
will do the work,and thesuucmm lsmaimended eraiered fmmlc(Sec.7041,Business Required Inspections
and Professions Code:The Connectors Licerue Law dm not apply m an owner or q p
progeny who builds or improves daemon.andwhodoessuch work himsellfor through his
awnemploym,provided Moloch improvements 4 in see vol Intended proBertd futsele It. �Ftl9op�
however,Ne building a improvement sold withane year intercepted., wn
pted.,Ne oer• 1 pWCqMs k kl
builder will have the burden of proving that he did net Wild or imp ve for purpose of
ince). I w..,- '
k1,u owner of Ne pmpeny,am mlc why covwcling with lice d conuaaors-BUILDING .
comWa the project(Sec.7014.8osinm and estiom Cade:) Causota'i li
come law dm not apply m an owner of p who WilW Brim ors themon,and,
who convects for such projects wiNac s)Iicenttdpunua to Ne Conlndoh
License law.
❑loom .B PC far Mi n
D& -7 /5 o
R CO SATION DFLLA ON
I he by no under penalty or perjury ane of Imo.(ptiming decluolom:
ave and will outlands
a CaNfresmaf Convent too sett-insure fur workers Compen.
on,as provided for by Sado.3700 of Me Labor Code.far Me pefmcca em of de
work for which this permit is iaucd.
❑1 have and will maintain Worgert Compensation Imunnce,as required by Section
3700 of Me labor Code,fa Me performance of rite work far which Nis permit in homed.
My Workers Compemadan tonna carrier end PoRcy nonWr are:
Cartier. Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Ills ttcda reed at emonpleted i(the permit 4 future huatlseddaRam($100)
or mat)
I cenify that in to perf nuance of Ne work for which MB Pomp 4 issued,l shall not
employ any person in any manerm a in became subject to de Workcn'Compensedan
Laws of Callfamia Data
Applicant
NOTICE TO APPLICANT:If.after making M4 Cer ificae of Exemption,you should
become subject an Me Worker's Compeueuon previsions of Me Labor Code,you must
O forthwith comply with such provisions o N4 permit W demand revoked.
Z y. CONSTRUCTION LENDING AGENCY
t-. 1 hereby".Mat Mort is a camtmctum ending agency far Me pert.mare or /VV
a
to wok fur which MIs permit is issued(Sec.3097,Civ,C.)
boy A Lender's Nwv
�Zlenders Address
U Q I cetefy Nat I hue read this application and sum der t e above eformadua 4
U,UCentel.I agree to comply with W su
city and county ordinances and e laws mm
testing
C building communion,and hereby suModre mPreernullws of this city to(NOWupon Me
W above-mentioned property for inspection purpose&
C1. (We)agree Io ave,indemnify and kee Me City or Cupertino against
(A Itabllities,judgmcnts.cost,and expensesw' m nayweyamaagumtstlO City
V 7 in eomequence of the grating of this niL
F7I APPLICANT UNI)ERS UNDERD COMPLY WITH LL NOPOINf Issued by: Date
SO
7 Re-roofs
Si of H o RDOUS MATERIALS DISCLOSURE or Dam Type of Roof
II Ne.mile or future building occup&m nom or handle heuNous materiel
ss dcOned by Me Cupertino Municipal Code.Chapter 9.13,roti dae HeaIN and S&(ery
cod,pv�7ss37(a)7 e4Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
havardous air contaminants u defined by Mc Bay Arco Air Quality Management all new materials for inspection.
VMS?
❑YesNu
I I ',mad Me hvaMnusmamr44re nen nderChaper 6.95 of Me Califon
nialealNkSefayCodc.Sccdam 7530 33a 534.lundmat ul Matlf Mc Wilding
dm rel curtend eve a en LN 4 pemlhillty m ttodfy dae eccupat of Nc
mgvim or man efsCutirNaearOccupancy. Signature of Applicant Date
`�S
pelt All roof coverings to be Class"B"or better
au .d0gcnl